Date Available

4-19-2021

Year of Publication

2021

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sheila Melander

Clinical Mentor

Dr. Michael Myers

Committee Member

Dr. Melanie Hardin-Pierce

Abstract

Abstract

Purpose: To establish the importance of early Advance Care Planning (ACP) and improve the utilization of Medical Orders for Scope of Treatment (MOST) forms in seriously ill patients by educating providers and nurses to identify patients who meet specified criteria. The goals of this intervention are reduction of readmissions and better quality of life for this patient population.

Methods: A quasi-experimental design was used for evaluation of an Educational intervention to promote MOST forms, Advance Directives (AD) and Palliative Care (PC) consults. A retrospective and prospective chart review was conducted to determine the number of patients who met criteria for ACP discharged from the intensive care unit (ICU) and progressive care unit (PCU) of the hospital in the three months before and the three months after implementing the Educational intervention by comparing the number of MOST forms, ADs, PC, and readmissions. A Pre and Post Education survey was conducted to assess the knowledge of the providers and the nurses on ADs and PC.

Results: The study identified no statistically significant differences in ADs, PC consults, and readmissions, in patients who met criteria for ACP according to the evidence-based tool pre and post Education. There was a decrease in the number of patients who died in the hospital post education. Although no MOST forms were documented, the knowledge of ADs post Education increased in the survey results and the knowledge of PC remained the same.

Conclusion: An educational intervention showed a modest reduction in hospital deaths but was not effective by itself in increasing ACP discussions, PC consults, or completion of MOST forms.

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